Pharm Anesthetics, Kinder I Flashcards Preview

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Flashcards in Pharm Anesthetics, Kinder I Deck (47):
1

What are the inhaled anesthetics

desflurane
enflurane
halothane
isoflurane
sevoflurane
NO

2

what inhaled anesthetic is not volatile

NO

3

what are the IV anesthetics

propofol
fospropofol
barbituates
benzos
etomidate
ketamine
desmedetomidine

4

what are the local anesthetics

esters: benzocaine, cocaine, procaine, tetracaine
amides: articaine
bupivicaine
lidocaine
mepivacaine
ropivacaine

5

What are the 5 primary effects produced by general anesthesia

unconsciousness
amnesia
analgesia
inhibition of autonomic reflexes
skel muscle relaxation

6

monitored anesthesia care

oral or parenteral sedatives with local anesthetics
profound analgesia with retention of ariway and response to verbal commands

7

anesthetic combination used for extensive surgical procedures

preoperative benzos with IV agent then maintained with inhaled or IV drugs or both

8

the higher the blood:gas ratio of inhaled anesthetics

slower the uptake

9

the higher the brain: blood ratio inhaled anesthetics

higher affinity to stay in CNS

10

if MAC>100 required

need to combine with other drug to achieve anesthesia

11

volatile

liquid at room temp

12

where are inhaled anesthetics taken up

lungs, gas exchange in alveoli

13

what is the driving force for uptake inhaled anesthetic

alveolar concentration

14

what determines how alveolar concentration changes

inspired concentration or partial P
alveolar ventilation

15

faster Fa (alveolar concentration) / Fi (inspired concentration) approaches 1

faster anesthesia will occur during inhaled induction

16

how does increased CO change inhaled anesthesia

increases uptake but distributes to all parts of body, not just CNS. decrease the rate of induction of anesthesia

17

if venous blood to lungs have less anesthetic than arterial (big difference)

more time to achieve equilibrium

18

which inhaled anesthetics are eliminated faster

the ones that are insoluble in blood and brain

19

how do anesthesiologists speed up recovery from anesthesia

hyperventilation

20

main route elimination of anesthetics

lungs

21

which inhaled anesthetics have the most hepatic metabolism component

halothane?enflurane>sevoflurane>isoflurane>desoflurane

22

Anesthetic potency is measured out

MAC minimum alveolar [ ]

23

1.0 MAC

partial P of inhaled anesthetic in alveoli which 50% population remained immobile at time of skin incision

24

range of MAC for successful anesthesia

0.5-2.0

25

4 stages of CNS depression

1 analgesia
2excitement
3 surgical anesthesia
4 medullary depression

26

stage 1: analgesia

begining only have analgesia
end have analgesia and amnesia

27

stage 2: excitement

patient delerious
respirations rapid, HR and BP increase

28

stage 3: surgical anesthesia

slow RR and HR until complete cessation spontaneous respiration
4 planes of ocular movements, eye reflexes and pupil sizes indicating increased depth anesthesia

29

stage 4: medullary depression

severe CNS depression including vasomotor in medulla and resp center
without circulatory/resp support would die

30

indications that in stage 3 anesthesia

loss of responsiveness to painful stimuli

31

patient has increased cranial P, don't give what anesthetic

volatile anesthetics

32

Which anesthetics depress normal cardiac contractility

volatile inhaled ones
halothane and enflurane more so

33

which volatile inhaled anesthetics increase HR

desflurane and isoflurane

34

what causes the postoperative respiratory complications like hypoxemia and resp infections

prolong exposure to inhaled anesthetics (resp depressors) cause mucus pooling and plugging leading to atelectasis

35

side effects inhaled anesthetics

nausea and vomiting
halothane-- hepattiis after previous 1st time exposure
renal toxicity-- sevoflurane
malignant hyperthermia!!!

36

Tx malignant hyperthermia

dantrolene

37

what caues rapid onset action IV anesthetics

highly lipophilic and thus bind to brain and spinal cord

38

MOA propofol

potentiation of Cl mediated thorugh GABA a

39

how is propofol made for infusion

lipid emulsion with egg yolk phosphate fraction (watch for allergies!!)

40

PK propofol

fast onset fast plasma clearance

41

what is context sensitive half time

elimination half time after discontinuation of continuous infusion as function of the duration of infusion

42

CNS effects propofol

general suppression
decreased cerebral blood flow
decreased intracranial and intraocular P
burst suppression in EEG

43

CV effects propofol

most pronounced dec in systemic BP from vasodilation
hypotensive effects from inhibition of normal baroreflex

44

respiratory effects propofol

respiratory depressant

45

painful injection

propofol

46

therapeutic use propofol

anesthesia induction, continous infusions, maintenance anesthesia, sedation ICU, consciou sedation, short duration general anesthesia
antiemetic!!!!

47

paresthesia in perianal area

fospropofol